Biostat 203B Homework 3

Due Feb 23 @ 11:59PM

Display machine information for reproducibility:

sessionInfo()

R version 4.2.3 (2023-03-15)
Platform: x86_64-apple-darwin17.0 (64-bit)
Running under: macOS Big Sur ... 10.16

Matrix products: default
BLAS:   /Library/Frameworks/R.framework/Versions/4.2/Resources/lib/libRblas.0.dylib
LAPACK: /Library/Frameworks/R.framework/Versions/4.2/Resources/lib/libRlapack.dylib

locale:
[1] en_US.UTF-8/en_US.UTF-8/en_US.UTF-8/C/en_US.UTF-8/en_US.UTF-8

attached base packages:
[1] stats     graphics  grDevices utils     datasets  methods   base     

loaded via a namespace (and not attached):
 [1] htmlwidgets_1.6.2 compiler_4.2.3    fastmap_1.1.1     cli_3.6.1        
 [5] tools_4.2.3       htmltools_0.5.5   rstudioapi_0.14   yaml_2.3.7       
 [9] rmarkdown_2.23    knitr_1.43        jsonlite_1.8.7    xfun_0.39        
[13] digest_0.6.32     rlang_1.1.1       evaluate_0.21    

Load necessary libraries (you can add more as needed).

library(arrow)

Warning:
  It appears that you are running R and Arrow in emulation (i.e. you're
  running an Intel version of R on a non-Intel mac). This configuration is
  not supported by arrow, you should install a native (arm64) build of R
  and use arrow with that. See https://cran.r-project.org/bin/macosx/

Attaching package: 'arrow'

The following object is masked from 'package:utils':

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library(memuse)
library(pryr)
library(R.utils)

Loading required package: R.oo

Loading required package: R.methodsS3

R.methodsS3 v1.8.2 (2022-06-13 22:00:14 UTC) successfully loaded. See ?R.methodsS3 for help.

R.oo v1.25.0 (2022-06-12 02:20:02 UTC) successfully loaded. See ?R.oo for help.

Attaching package: 'R.oo'

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Attaching package: 'R.utils'

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library(tidyverse)

── Attaching core tidyverse packages ──────────────────────── tidyverse 2.0.0 ──
✔ dplyr     1.1.2     ✔ readr     2.1.4
✔ forcats   1.0.0     ✔ stringr   1.5.0
✔ ggplot2   3.4.2     ✔ tibble    3.2.1
✔ lubridate 1.9.2     ✔ tidyr     1.3.0
✔ purrr     1.0.1     

── Conflicts ────────────────────────────────────────── tidyverse_conflicts() ──
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library(plotly)

Attaching package: 'plotly'

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Display your machine memory.

memuse::Sys.meminfo()

Totalram:    8.000 GiB 
Freeram:   243.016 MiB 

In this exercise, we use tidyverse (ggplot2, dplyr, etc) to explore the MIMIC-IV data introduced in homework 1 and to build a cohort of ICU stays.

Q1. Visualizing patient trajectory

Visualizing a patient’s encounters in a health care system is a common task in clinical data analysis. In this question, we will visualize a patient’s ADT (admission-discharge-transfer) history and ICU vitals in the MIMIC-IV data.

Q1.1 ADT history

A patient’s ADT history records the time of admission, discharge, and transfer in the hospital. This figure shows the ADT history of the patient with subject_id 10001217 in the MIMIC-IV data. The x-axis is the calendar time, and the y-axis is the type of event (ADT, lab, procedure). The color of the line segment represents the care unit. The size of the line segment represents whether the care unit is an ICU/CCU. The crosses represent lab events, and the shape of the dots represents the type of procedure. The title of the figure shows the patient’s demographic information and the subtitle shows top 3 diagnoses.

Do a similar visualization for the patient with subject_id 10013310 using ggplot.

Hint: We need to pull information from data files patients.csv.gz, admissions.csv.gz, transfers.csv.gz, labevents.csv.gz, procedures_icd.csv.gz, diagnoses_icd.csv.gz, d_icd_procedures.csv.gz, and d_icd_diagnoses.csv.gz. For the big file labevents.csv.gz, use the Parquet format you generated in Homework 2. For reproducibility, make the Parquet folder labevents_pq available at the current working directory hw3, for example, by a symbolic link. Make your code reproducible.

Answer:

First Read the data:

labevents_tble <- arrow::open_dataset("~/mimic/hosp/labevents.parquet")
patients_tble <- read_csv("~/mimic/hosp/patients.csv.gz")

Rows: 299712 Columns: 6
── Column specification ────────────────────────────────────────────────────────
Delimiter: ","
chr  (2): gender, anchor_year_group
dbl  (3): subject_id, anchor_age, anchor_year
date (1): dod

ℹ Use `spec()` to retrieve the full column specification for this data.
ℹ Specify the column types or set `show_col_types = FALSE` to quiet this message.

admissions_tble <- read_csv("~/mimic/hosp/admissions.csv.gz")

Rows: 431231 Columns: 16
── Column specification ────────────────────────────────────────────────────────
Delimiter: ","
chr  (8): admission_type, admit_provider_id, admission_location, discharge_l...
dbl  (3): subject_id, hadm_id, hospital_expire_flag
dttm (5): admittime, dischtime, deathtime, edregtime, edouttime

ℹ Use `spec()` to retrieve the full column specification for this data.
ℹ Specify the column types or set `show_col_types = FALSE` to quiet this message.

transfers_tble <- read_csv("~/mimic/hosp/transfers.csv.gz")

Rows: 1890972 Columns: 7
── Column specification ────────────────────────────────────────────────────────
Delimiter: ","
chr  (2): eventtype, careunit
dbl  (3): subject_id, hadm_id, transfer_id
dttm (2): intime, outtime

ℹ Use `spec()` to retrieve the full column specification for this data.
ℹ Specify the column types or set `show_col_types = FALSE` to quiet this message.

procedures_icd_tble <- read_csv("~/mimic/hosp/procedures_icd.csv.gz")

Rows: 669186 Columns: 6
── Column specification ────────────────────────────────────────────────────────
Delimiter: ","
chr  (1): icd_code
dbl  (4): subject_id, hadm_id, seq_num, icd_version
date (1): chartdate

ℹ Use `spec()` to retrieve the full column specification for this data.
ℹ Specify the column types or set `show_col_types = FALSE` to quiet this message.

diagnoses_icd_tble <- read_csv("~/mimic/hosp/diagnoses_icd.csv.gz")

Rows: 4756326 Columns: 5
── Column specification ────────────────────────────────────────────────────────
Delimiter: ","
chr (1): icd_code
dbl (4): subject_id, hadm_id, seq_num, icd_version

ℹ Use `spec()` to retrieve the full column specification for this data.
ℹ Specify the column types or set `show_col_types = FALSE` to quiet this message.

d_icd_procedures_tble <- read_csv("~/mimic/hosp/d_icd_procedures.csv.gz")

Rows: 85257 Columns: 3
── Column specification ────────────────────────────────────────────────────────
Delimiter: ","
chr (2): icd_code, long_title
dbl (1): icd_version

ℹ Use `spec()` to retrieve the full column specification for this data.
ℹ Specify the column types or set `show_col_types = FALSE` to quiet this message.

d_icd_diagnoses_tble <- read_csv("~/mimic/hosp/d_icd_diagnoses.csv.gz")

Rows: 109775 Columns: 3
── Column specification ────────────────────────────────────────────────────────
Delimiter: ","
chr (2): icd_code, long_title
dbl (1): icd_version

ℹ Use `spec()` to retrieve the full column specification for this data.
ℹ Specify the column types or set `show_col_types = FALSE` to quiet this message.

patients <- read_csv("~/mimic/hosp/patients.csv.gz")

Rows: 299712 Columns: 6
── Column specification ────────────────────────────────────────────────────────
Delimiter: ","
chr  (2): gender, anchor_year_group
dbl  (3): subject_id, anchor_age, anchor_year
date (1): dod

ℹ Use `spec()` to retrieve the full column specification for this data.
ℹ Specify the column types or set `show_col_types = FALSE` to quiet this message.

Filter data for the patient with subject_id 10013310

patient_id <- 10013310
patient_admissions <- admissions_tble %>%
  filter(subject_id == patient_id)

patient_transfers <- transfers_tble %>%
  filter(subject_id == patient_id)

labevents_tble <- as.data.frame(labevents_tble)
patient_labevents <- labevents_tble %>%
  filter(subject_id == patient_id)

patient_procedures <- procedures_icd_tble %>%
  filter(subject_id == patient_id)

patient_diagnoses <- diagnoses_icd_tble %>%
  filter(subject_id == patient_id)

patients <- patients %>%
  filter(subject_id == patient_id)

Merge relevant data tables:

patient_procedures <- patient_procedures %>%
  left_join(d_icd_procedures_tble, by = "icd_code") %>%
  select(subject_id, hadm_id, icd_code, chartdate, long_title)

patient_diagnoses <- patient_diagnoses %>%
  left_join(d_icd_diagnoses_tble, by = "icd_code") %>%
  select(subject_id, hadm_id, icd_code, long_title)

Visualize the ADT history:

icu_ccu_rows <- patient_transfers[grepl("ICU|CCU", patient_transfers$careunit), ]

patient_procedures$chartdate <- as.POSIXct(patient_procedures$chartdate)
patient_transfers <- patient_transfers[complete.cases(patient_transfers$careunit, patient_transfers$intime, patient_transfers$outtime), ]
patient_procedures$long_title <- as.factor(patient_procedures$long_title)

convert_to_text <- function(x) {
  y_labels <- c("  ","Procedure", "  "," Lab", "  ", "ADT")
  y_labels[ceiling(x * length(y_labels))]
}

truncate_legend <- function(x, max_chars) {
  ifelse(nchar(x) > max_chars, substr(x, 1, max_chars), x)
}

title_freq <- table(patient_diagnoses$long_title)

top_three_titles <- names(sort(title_freq, decreasing = TRUE)[1:3])

subtitle <- sprintf("\n%s\n%s\n%s", top_three_titles[1], top_three_titles[2], top_three_titles[3])

ggplot() +
  geom_segment(data = patient_transfers, aes(x = intime, xend = outtime, 
                                             color = careunit, y = 1, yend = 1, 
                                             linewidth= ifelse(transfer_id==icu_ccu_rows$transfer_id, 
                                                               2, 1.5),)) +
  geom_point(data = patient_labevents, aes(x = charttime, y = 0.6), shape = "x") +
  geom_point(data = patient_procedures, 
             aes(x = chartdate, y = 0.2, shape = long_title)) +
  scale_shape_manual(values = 0:10,labels = truncate_legend(
    levels(patient_procedures$long_title),15))+
  scale_x_datetime(labels = scales::date_format("%m-%d")) +
  scale_y_continuous(labels = convert_to_text) +
  labs(title = paste("Patient", patient_admissions$subject_id,patients$gender,
                     patients$anchor_age,
                     patient_admissions$race),
       subtitle = subtitle,
       x=("Calendar Time"), y=(" "))+
  guides(linewidth = "none", shape = guide_legend(title = "Procedure",ncol = 1), 
         color = guide_legend(ncol  = 1, title = "Care Unit"))+
  theme_minimal()+
  theme(legend.position = "bottom")

Warning in transfer_id == icu_ccu_rows$transfer_id: longer object length is not
a multiple of shorter object length

Warning in transfer_id == icu_ccu_rows$transfer_id: longer object length is not
a multiple of shorter object length

Q1.2 ICU stays

ICU stays are a subset of ADT history. This figure shows the vitals of the patient 10001217 during ICU stays. The x-axis is the calendar time, and the y-axis is the value of the vital. The color of the line represents the type of vital. The facet grid shows the abbreviation of the vital and the stay ID.

Do a similar visualization for the patient 10013310.

Answer:

Since the cjartevents data is too large, I will make a parquet file for the chartevents data and then read it in R, so that I can use it more efficiently in the later procedures.

zcat < ~/mimic/icu/chartevents.csv.gz > ~/mimic/icu/chartevents.csv

#chartevents <- arrow::open_dataset("~/mimic/icu/chartevents.csv", format = "csv")
#chartevents_parquet <- arrow::write_parquet(chartevents, "~/mimic/icu/chartevents.parquet")

icu_stays <- read_csv("~/mimic/icu/icustays.csv.gz")

Rows: 73181 Columns: 8
── Column specification ────────────────────────────────────────────────────────
Delimiter: ","
chr  (2): first_careunit, last_careunit
dbl  (4): subject_id, hadm_id, stay_id, los
dttm (2): intime, outtime

ℹ Use `spec()` to retrieve the full column specification for this data.
ℹ Specify the column types or set `show_col_types = FALSE` to quiet this message.

d_items <- read_csv("~/mimic/icu/d_items.csv.gz")

Rows: 4014 Columns: 9
── Column specification ────────────────────────────────────────────────────────
Delimiter: ","
chr (6): label, abbreviation, linksto, category, unitname, param_type
dbl (3): itemid, lownormalvalue, highnormalvalue

ℹ Use `spec()` to retrieve the full column specification for this data.
ℹ Specify the column types or set `show_col_types = FALSE` to quiet this message.

chartevents <- arrow::open_dataset("~/mimic/icu/chartevents.parquet")

icu_stays_patient <- icu_stays %>%
  filter(subject_id == 10013310)


chartevents_patient <- chartevents %>%
  filter(subject_id == 10013310)
chartevents_patient <- as.data.frame(chartevents_patient)

condition <- d_items$linksto == "chartevents" & d_items$abbreviation %in% 
  c("HR", "NBPd", "NBPs", "RR", "Temperature F")
filtered_items <- d_items$itemid[condition]
d_items_need <- d_items %>%
  filter(itemid %in% filtered_items)

chartevents_patient <- chartevents_patient %>%
  filter(itemid %in% filtered_items) %>%
  left_join(d_items_need, by = "itemid") %>%
  select(subject_id, stay_id,charttime, value, valuenum, abbreviation, itemid)

chartevents_patient$charttime <- as.POSIXct(chartevents_patient$charttime)
chartevents_patient$stay_id <- as.factor(chartevents_patient$stay_id)
chartevents_patient$abbreviation <- as.factor(chartevents_patient$abbreviation)

ggplot() +
  geom_line(data = chartevents_patient, aes(x = charttime, y = valuenum, 
                                            group = interaction(stay_id, abbreviation), 
                                            color = interaction(stay_id, abbreviation))) +
  geom_point(data = chartevents_patient, aes(x = charttime, y = valuenum, 
                                             group = interaction(stay_id, abbreviation), 
                                             color = interaction(stay_id, abbreviation))) +
  labs(title = paste("Stay ID:", chartevents_patient$stay_id),
       x = "Time",
       y = "Value") +
  facet_grid(cols = vars(stay_id), rows = vars(abbreviation), scales = "free") +
  guides(color = FALSE) +
  theme_minimal() +
  theme(axis.text.x = element_text(angle = 20, hjust = 1),
        strip.background = element_rect(fill = "lightgray")) +
  scale_x_datetime(labels = scales::date_format("%m-%d %H:%M")) +
  scale_color_manual(values = c("orange", "orange", "yellow4", "yellow4", 
                                "springgreen3",  "springgreen3", "deepskyblue",
                                "deepskyblue", "magenta2", "magenta2"))

Warning: The `<scale>` argument of `guides()` cannot be `FALSE`. Use "none" instead as
of ggplot2 3.3.4.

Q2. ICU stays

icustays.csv.gz (https://mimic.mit.edu/docs/iv/modules/icu/icustays/) contains data about Intensive Care Units (ICU) stays. The first 10 lines are

zcat < ~/mimic/icu/icustays.csv.gz | head

subject_id,hadm_id,stay_id,first_careunit,last_careunit,intime,outtime,los
10000032,29079034,39553978,Medical Intensive Care Unit (MICU),Medical Intensive Care Unit (MICU),2180-07-23 14:00:00,2180-07-23 23:50:47,0.4102662037037037
10000980,26913865,39765666,Medical Intensive Care Unit (MICU),Medical Intensive Care Unit (MICU),2189-06-27 08:42:00,2189-06-27 20:38:27,0.4975347222222222
10001217,24597018,37067082,Surgical Intensive Care Unit (SICU),Surgical Intensive Care Unit (SICU),2157-11-20 19:18:02,2157-11-21 22:08:00,1.1180324074074075
10001217,27703517,34592300,Surgical Intensive Care Unit (SICU),Surgical Intensive Care Unit (SICU),2157-12-19 15:42:24,2157-12-20 14:27:41,0.9481134259259258
10001725,25563031,31205490,Medical/Surgical Intensive Care Unit (MICU/SICU),Medical/Surgical Intensive Care Unit (MICU/SICU),2110-04-11 15:52:22,2110-04-12 23:59:56,1.338587962962963
10001884,26184834,37510196,Medical Intensive Care Unit (MICU),Medical Intensive Care Unit (MICU),2131-01-11 04:20:05,2131-01-20 08:27:30,9.171817129629629
10002013,23581541,39060235,Cardiac Vascular Intensive Care Unit (CVICU),Cardiac Vascular Intensive Care Unit (CVICU),2160-05-18 10:00:53,2160-05-19 17:33:33,1.3143518518518518
10002155,20345487,32358465,Medical Intensive Care Unit (MICU),Medical Intensive Care Unit (MICU),2131-03-09 21:33:00,2131-03-10 18:09:21,0.8585763888888889
10002155,23822395,33685454,Coronary Care Unit (CCU),Coronary Care Unit (CCU),2129-08-04 12:45:00,2129-08-10 17:02:38,6.178912037037037

Q2.1 Ingestion

Import icustays.csv.gz as a tibble icustays_tble.

Answer:

icustays_tble <- as_tibble(read_csv("~/mimic/icu/icustays.csv.gz"))

Rows: 73181 Columns: 8
── Column specification ────────────────────────────────────────────────────────
Delimiter: ","
chr  (2): first_careunit, last_careunit
dbl  (4): subject_id, hadm_id, stay_id, los
dttm (2): intime, outtime

ℹ Use `spec()` to retrieve the full column specification for this data.
ℹ Specify the column types or set `show_col_types = FALSE` to quiet this message.

Q2.2 Summary and visualization

How many unique subject_id? Can a subject_id have multiple ICU stays? Summarize the number of ICU stays per subject_id by graphs.

Answer: Here is the number of unique subject_id:

unique_subject_id <- icustays_tble %>%
  distinct(subject_id) %>%
  count()

unique_subject_id

# A tibble: 1 × 1
      n
  <int>
1 50920

Yes, a subject_id can have multiple ICU stays. Here is the summary of the number of ICU stays per subject_id:

icu_stays_summary <- icustays_tble %>%
  distinct(subject_id, stay_id) %>%
  group_by(subject_id) %>%
  count() %>%
  arrange(desc(n))

head(icu_stays_summary, 5)

# A tibble: 5 × 2
# Groups:   subject_id [5]
  subject_id     n
       <dbl> <int>
1   18358138    37
2   12468016    33
3   17585185    33
4   13269859    30
5   18676703    26

Here is the graph of the number of ICU stays per subject_id:

plot <- ggplot(data= icu_stays_summary) +
  geom_bar(mapping = aes(x = n)) +
  labs(title = "Number of unique subject_id",
       x = "Count ICU stays",
       y = "Count subject_id") +
  theme_minimal()+
  theme(axis.text.x = element_text(angle = 90, hjust = 1))+
  scale_x_discrete(limits = icu_stays_summary$n)

Warning: Continuous limits supplied to discrete scale.
ℹ Did you mean `limits = factor(...)` or `scale_*_continuous()`?

plotly_plot <- ggplotly(plot)
plotly_plot

Over 75% of the patient only have one ICU stay.

Q3. admissions data

Information of the patients admitted into hospital is available in admissions.csv.gz. See https://mimic.mit.edu/docs/iv/modules/hosp/admissions/ for details of each field in this file. The first 10 lines are

zcat < ~/mimic/hosp/admissions.csv.gz | head

subject_id,hadm_id,admittime,dischtime,deathtime,admission_type,admit_provider_id,admission_location,discharge_location,insurance,language,marital_status,race,edregtime,edouttime,hospital_expire_flag
10000032,22595853,2180-05-06 22:23:00,2180-05-07 17:15:00,,URGENT,P874LG,TRANSFER FROM HOSPITAL,HOME,Other,ENGLISH,WIDOWED,WHITE,2180-05-06 19:17:00,2180-05-06 23:30:00,0
10000032,22841357,2180-06-26 18:27:00,2180-06-27 18:49:00,,EW EMER.,P09Q6Y,EMERGENCY ROOM,HOME,Medicaid,ENGLISH,WIDOWED,WHITE,2180-06-26 15:54:00,2180-06-26 21:31:00,0
10000032,25742920,2180-08-05 23:44:00,2180-08-07 17:50:00,,EW EMER.,P60CC5,EMERGENCY ROOM,HOSPICE,Medicaid,ENGLISH,WIDOWED,WHITE,2180-08-05 20:58:00,2180-08-06 01:44:00,0
10000032,29079034,2180-07-23 12:35:00,2180-07-25 17:55:00,,EW EMER.,P30KEH,EMERGENCY ROOM,HOME,Medicaid,ENGLISH,WIDOWED,WHITE,2180-07-23 05:54:00,2180-07-23 14:00:00,0
10000068,25022803,2160-03-03 23:16:00,2160-03-04 06:26:00,,EU OBSERVATION,P51VDL,EMERGENCY ROOM,,Other,ENGLISH,SINGLE,WHITE,2160-03-03 21:55:00,2160-03-04 06:26:00,0
10000084,23052089,2160-11-21 01:56:00,2160-11-25 14:52:00,,EW EMER.,P6957U,WALK-IN/SELF REFERRAL,HOME HEALTH CARE,Medicare,ENGLISH,MARRIED,WHITE,2160-11-20 20:36:00,2160-11-21 03:20:00,0
10000084,29888819,2160-12-28 05:11:00,2160-12-28 16:07:00,,EU OBSERVATION,P63AD6,PHYSICIAN REFERRAL,,Medicare,ENGLISH,MARRIED,WHITE,2160-12-27 18:32:00,2160-12-28 16:07:00,0
10000108,27250926,2163-09-27 23:17:00,2163-09-28 09:04:00,,EU OBSERVATION,P38XXV,EMERGENCY ROOM,,Other,ENGLISH,SINGLE,WHITE,2163-09-27 16:18:00,2163-09-28 09:04:00,0
10000117,22927623,2181-11-15 02:05:00,2181-11-15 14:52:00,,EU OBSERVATION,P2358X,EMERGENCY ROOM,,Other,ENGLISH,DIVORCED,WHITE,2181-11-14 21:51:00,2181-11-15 09:57:00,0

Q3.1 Ingestion

Import admissions.csv.gz as a tibble admissions_tble.

Answer:

admissions_tble <- as_tibble(read_csv("~/mimic/hosp/admissions.csv.gz"))

Rows: 431231 Columns: 16
── Column specification ────────────────────────────────────────────────────────
Delimiter: ","
chr  (8): admission_type, admit_provider_id, admission_location, discharge_l...
dbl  (3): subject_id, hadm_id, hospital_expire_flag
dttm (5): admittime, dischtime, deathtime, edregtime, edouttime

ℹ Use `spec()` to retrieve the full column specification for this data.
ℹ Specify the column types or set `show_col_types = FALSE` to quiet this message.

Q3.2 Summary and visualization

Summarize the following information by graphics and explain any patterns you see.

• number of admissions per patient
  
• admission hour (anything unusual?)
  
• admission minute (anything unusual?)
  
• length of hospital stay (from admission to discharge) (anything unusual?)

According to the MIMIC-IV documentation,

All dates in the database have been shifted to protect patient confidentiality. Dates will be internally consistent for the same patient, but randomly distributed in the future. Dates of birth which occur in the present time are not true dates of birth. Furthermore, dates of birth which occur before the year 1900 occur if the patient is older than 89. In these cases, the patient’s age at their first admission has been fixed to 300.

Answer:

Number of admissions per patient:

admissions_summary <- admissions_tble %>%
  distinct(subject_id, hadm_id) %>%
  group_by(subject_id) %>%
  count() %>%
  arrange(desc(n))

plot <- ggplot(data= admissions_summary) +
  geom_bar(mapping = aes(x = n)) +
  labs(title = "Number of admissions per patient",
       x = "Count admissions",
       y = "Count subject_id") +
  theme_minimal()+
  theme(axis.text.x = element_text(angle = 90, hjust = 1))

plotly_plot <- ggplotly(plot)
plotly_plot

We can see that over 100,000 patients have only one admission, about 35,000 patients have two admissions, and about 15,000 patients have three admissions. Only 15.43% of patients have more than 3 admissions.

Admission hour:

Q4. patients data

Patient information is available in patients.csv.gz. See https://mimic.mit.edu/docs/iv/modules/hosp/patients/ for details of each field in this file. The first 10 lines are

zcat < ~/mimic/hosp/patients.csv.gz | head

subject_id,gender,anchor_age,anchor_year,anchor_year_group,dod
10000032,F,52,2180,2014 - 2016,2180-09-09
10000048,F,23,2126,2008 - 2010,
10000068,F,19,2160,2008 - 2010,
10000084,M,72,2160,2017 - 2019,2161-02-13
10000102,F,27,2136,2008 - 2010,
10000108,M,25,2163,2014 - 2016,
10000115,M,24,2154,2017 - 2019,
10000117,F,48,2174,2008 - 2010,
10000178,F,59,2157,2017 - 2019,

Q4.1 Ingestion

Import patients.csv.gz (https://mimic.mit.edu/docs/iv/modules/hosp/patients/) as a tibble patients_tble.

Answer:

patients_tble <- as_tibble(read_csv("~/mimic/hosp/patients.csv.gz"))

Rows: 299712 Columns: 6
── Column specification ────────────────────────────────────────────────────────
Delimiter: ","
chr  (2): gender, anchor_year_group
dbl  (3): subject_id, anchor_age, anchor_year
date (1): dod

ℹ Use `spec()` to retrieve the full column specification for this data.
ℹ Specify the column types or set `show_col_types = FALSE` to quiet this message.

Q4.2 Summary and visualization

Summarize variables gender and anchor_age by graphics, and explain any patterns you see.

Q5. Lab results

labevents.csv.gz (https://mimic.mit.edu/docs/iv/modules/hosp/labevents/) contains all laboratory measurements for patients. The first 10 lines are

zcat < ~/mimic/hosp/labevents.csv.gz | head

labevent_id,subject_id,hadm_id,specimen_id,itemid,order_provider_id,charttime,storetime,value,valuenum,valueuom,ref_range_lower,ref_range_upper,flag,priority,comments
1,10000032,,45421181,51237,P28Z0X,2180-03-23 11:51:00,2180-03-23 15:15:00,1.4,1.4,,0.9,1.1,abnormal,ROUTINE,
2,10000032,,45421181,51274,P28Z0X,2180-03-23 11:51:00,2180-03-23 15:15:00,___,15.1,sec,9.4,12.5,abnormal,ROUTINE,VERIFIED.
3,10000032,,52958335,50853,P28Z0X,2180-03-23 11:51:00,2180-03-25 11:06:00,___,15,ng/mL,30,60,abnormal,ROUTINE,NEW ASSAY IN USE ___: DETECTS D2 AND D3 25-OH ACCURATELY.
4,10000032,,52958335,50861,P28Z0X,2180-03-23 11:51:00,2180-03-23 16:40:00,102,102,IU/L,0,40,abnormal,ROUTINE,
5,10000032,,52958335,50862,P28Z0X,2180-03-23 11:51:00,2180-03-23 16:40:00,3.3,3.3,g/dL,3.5,5.2,abnormal,ROUTINE,
6,10000032,,52958335,50863,P28Z0X,2180-03-23 11:51:00,2180-03-23 16:40:00,109,109,IU/L,35,105,abnormal,ROUTINE,
7,10000032,,52958335,50864,P28Z0X,2180-03-23 11:51:00,2180-03-23 16:40:00,___,8,ng/mL,0,8.7,,ROUTINE,MEASURED BY ___.
8,10000032,,52958335,50868,P28Z0X,2180-03-23 11:51:00,2180-03-23 16:40:00,12,12,mEq/L,8,20,,ROUTINE,
9,10000032,,52958335,50878,P28Z0X,2180-03-23 11:51:00,2180-03-23 16:40:00,143,143,IU/L,0,40,abnormal,ROUTINE,

d_labitems.csv.gz (https://mimic.mit.edu/docs/iv/modules/hosp/d_labitems/) is the dictionary of lab measurements.

zcat < ~/mimic/hosp/d_labitems.csv.gz | head

itemid,label,fluid,category
50801,Alveolar-arterial Gradient,Blood,Blood Gas
50802,Base Excess,Blood,Blood Gas
50803,"Calculated Bicarbonate, Whole Blood",Blood,Blood Gas
50804,Calculated Total CO2,Blood,Blood Gas
50805,Carboxyhemoglobin,Blood,Blood Gas
50806,"Chloride, Whole Blood",Blood,Blood Gas
50808,Free Calcium,Blood,Blood Gas
50809,Glucose,Blood,Blood Gas
50810,"Hematocrit, Calculated",Blood,Blood Gas

We are interested in the lab measurements of creatinine (50912), potassium (50971), sodium (50983), chloride (50902), bicarbonate (50882), hematocrit (51221), white blood cell count (51301), and glucose (50931). Retrieve a subset of labevents.csv.gz that only containing these items for the patients in icustays_tble. Further restrict to the last available measurement (by storetime) before the ICU stay. The final labevents_tble should have one row per ICU stay and columns for each lab measurement.

Hint: Use the Parquet format you generated in Homework 2. For reproducibility, make labevents_pq folder available at the current working directory hw3, for example, by a symbolic link.

Q6. Vitals from charted events

chartevents.csv.gz (https://mimic.mit.edu/docs/iv/modules/icu/chartevents/) contains all the charted data available for a patient. During their ICU stay, the primary repository of a patient’s information is their electronic chart. The itemid variable indicates a single measurement type in the database. The value variable is the value measured for itemid. The first 10 lines of chartevents.csv.gz are

zcat < ~/mimic/icu/chartevents.csv.gz | head

subject_id,hadm_id,stay_id,caregiver_id,charttime,storetime,itemid,value,valuenum,valueuom,warning
10000032,29079034,39553978,47007,2180-07-23 21:01:00,2180-07-23 22:15:00,220179,82,82,mmHg,0
10000032,29079034,39553978,47007,2180-07-23 21:01:00,2180-07-23 22:15:00,220180,59,59,mmHg,0
10000032,29079034,39553978,47007,2180-07-23 21:01:00,2180-07-23 22:15:00,220181,63,63,mmHg,0
10000032,29079034,39553978,47007,2180-07-23 22:00:00,2180-07-23 22:15:00,220045,94,94,bpm,0
10000032,29079034,39553978,47007,2180-07-23 22:00:00,2180-07-23 22:15:00,220179,85,85,mmHg,0
10000032,29079034,39553978,47007,2180-07-23 22:00:00,2180-07-23 22:15:00,220180,55,55,mmHg,0
10000032,29079034,39553978,47007,2180-07-23 22:00:00,2180-07-23 22:15:00,220181,62,62,mmHg,0
10000032,29079034,39553978,47007,2180-07-23 22:00:00,2180-07-23 22:15:00,220210,20,20,insp/min,0
10000032,29079034,39553978,47007,2180-07-23 22:00:00,2180-07-23 22:15:00,220277,95,95,%,0

d_items.csv.gz (https://mimic.mit.edu/docs/iv/modules/icu/d_items/) is the dictionary for the itemid in chartevents.csv.gz.

zcat < ~/mimic/icu/d_items.csv.gz | head

itemid,label,abbreviation,linksto,category,unitname,param_type,lownormalvalue,highnormalvalue
220001,Problem List,Problem List,chartevents,General,,Text,,
220003,ICU Admission date,ICU Admission date,datetimeevents,ADT,,Date and time,,
220045,Heart Rate,HR,chartevents,Routine Vital Signs,bpm,Numeric,,
220046,Heart rate Alarm - High,HR Alarm - High,chartevents,Alarms,bpm,Numeric,,
220047,Heart Rate Alarm - Low,HR Alarm - Low,chartevents,Alarms,bpm,Numeric,,
220048,Heart Rhythm,Heart Rhythm,chartevents,Routine Vital Signs,,Text,,
220050,Arterial Blood Pressure systolic,ABPs,chartevents,Routine Vital Signs,mmHg,Numeric,90,140
220051,Arterial Blood Pressure diastolic,ABPd,chartevents,Routine Vital Signs,mmHg,Numeric,60,90
220052,Arterial Blood Pressure mean,ABPm,chartevents,Routine Vital Signs,mmHg,Numeric,,

We are interested in the vitals for ICU patients: heart rate (220045), systolic non-invasive blood pressure (220179), diastolic non-invasive blood pressure (220180), body temperature in Fahrenheit (223761), and respiratory rate (220210). Retrieve a subset of chartevents.csv.gz only containing these items for the patients in icustays_tble. Further restrict to the first vital measurement within the ICU stay. The final chartevents_tble should have one row per ICU stay and columns for each vital measurement.

Hint: Use the Parquet format you generated in Homework 2. For reproducibility, make chartevents_pq folder available at the current working directory, for example, by a symbolic link.

Q7. Putting things together

Let us create a tibble mimic_icu_cohort for all ICU stays, where rows are all ICU stays of adults (age at intime >= 18) and columns contain at least following variables

• all variables in icustays_tble
  
• all variables in admissions_tble
  
• all variables in patients_tble
• the last lab measurements before the ICU stay in labevents_tble
• the first vital measurements during the ICU stay in chartevents_tble

The final mimic_icu_cohort should have one row per ICU stay and columns for each variable.

Q8. Exploratory data analysis (EDA)

Summarize the following information about the ICU stay cohort mimic_icu_cohort using appropriate numerics or graphs:

• Length of ICU stay los vs demographic variables (race, insurance, marital_status, gender, age at intime)

• Length of ICU stay los vs the last available lab measurements before ICU stay

• Length of ICU stay los vs the average vital measurements within the first hour of ICU stay

• Length of ICU stay los vs first ICU unit